Background Infectious keratitis is a major cause of global blindness. We tested whether standalone photoactivated chromophore corneal cross-linking (PACK-CXL) may be an effective first-line treatment in early to moderate infectious keratitis, compared with standard antimicrobial treatment. Methods This is a randomized, controlled, multinational phase 3 clinical trial. Participants in five centers in Egypt, India, Iran, Israel, and China, aged ≥ 18 years, with infectious keratitis of presumed bacterial, fungal, or mixed origin, were randomly assigned (1:1) to PACK-CXL, or antimicrobial therapy. Outcomes measures included healing, defined as time to re-epithelialization of the corneal epithelial defect in the absence of inflammatory activity in the anterior chamber and clearance of stromal infiltrates. Treatment success was defined as the complete resolution of signs of infection. Results Between July 21, 2016, and March 4, 2020, participants were randomly assigned to receive PACK-CXL (n = 18) or antimicrobial therapy per American Academy of Ophthalmology (AAO) guidelines (n = 21). No participants were lost to follow-up. Four eyes were excluded from the epithelialization time analysis due to treatment failure: two in the antimicrobial therapy group, and two in the PACK-CXL group. Success rates were 88.9% (16/18 patients) in the PACK-CXL group and 90.5% (19/21 patients) in the medication group. There was no significant difference in time to complete corneal re-epithelialization (P = 0.828) between both treatment groups. Conclusions PACK-CXL may be an alternative to antimicrobial drugs for first-line and standalone treatment of early to moderate infectious keratitis of bacterial or fungal origin. Trial registration This trial is registered at ClinicalTrials.gov, trial registration number: NCT02717871

Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection among mechanically ventilated patients. Our objectives were to determine the incidence of VAP, isolate multidrug-resistant bacteria, identify the most prevalent resistant strains and identify their antibiotic susceptibility pattern. The VAP rate was calculated. The isolated microbes were identified and tested for antibiotic susceptibilities. The minimum inhibitory concentrations were determined of imipenem, meropenem and ertapenem for Klebsiella isolates. Klebsiella isolates resistant to carbapenems were tested for the presence of the blaKPC gene. The VAP incidence density rate was 48.8 incidences/1 000 ventilator days. The most common Gram-positive organism was Staphylococcus aureus, of which 86.6% of isolates were resistant to cefoxitin , but 100% were sensitive to teicoplanin, linezolid and tigecycline. The most common Gram-negative bacillus was Klebsiella, of which 94.6% of isolates were resistant to cefotaxime, 70.2% to imipenem, and 64.9% to ertapenem, but 100% were sensitive to colistin and 94.6% were sensitive to tigecycline. Of the carbapenem-resistant Klebsiella strains, 23.1% had the blaKPC gene. The high rates of VAP and the high rates of resistance among isolated organisms point to improper implementation of infection control programmes. Bactéries multirésistantes parmi les patients atteints de pneumonie associée à la ventilation dans une unité de soins intensifs d'urgence, Égypte RÉSUMÉ La pneumonie sous ventilation assistée (PVA) est la forme la plus courante d'infections nosocomiales contractées par les patients sous ventilation artificielle. L'objectif de la présente étude consistait à déterminer l'incidence de la PVA, à isoler les bactéries multirésistantes, et à identifier les souches résistantes les plus prévalentes ainsi que leur profil de sensibilité aux antibiotiques. Le taux de PVA a été calculé. Les microbes isolés ont été identifiés et leur sensibilité aux antibiotiques a été testée. Les concentrations minimales inhibitrices ont été déterminées pour l'imipénème, le méropénème et l'ertapénem pour les isolats de Klebsiella. Les isolats de Klebsiella résistants aux carbapénèmes ont été testés afin de déterminer la présence du gène blaKPC. Le taux de PVA était de 48,8 cas/1000 jours de ventilation. L'organisme à Gram positif le plus courant était Staphylococcus aureus, dont 86,6 % des isolats étaient résistants à la céfoxitine, mais 100 % étaient sensibles à la teicoplanine, au linézolide et à la tigécycline. Le bacille à Gram négatif le plus courant était Klebsiella, dont 94,6 % des isolats étaient résistants à la céfotaxime, 70,2 % à l'imipénème, et 64,9 % à l'ertapénem, mais 100 % étaient sensibles à la colistine et 94,6 % à la tigécycline. Parmi les souches de Klebsiella résistantes aux carbapénèmes, 23,1 % contenaient le gène blaKPC. Les taux élevés de PVA et de résistance parmi les organismes isolés indiquent une mise en oeuvre inadéquate des programmes de lutte contre les infections.

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The prevalence of enterotoxigenic Staphylococcus aureus was investigated among 200 participants working in three different food processing plants in Egypt. Using skin swabs, 75 (38%) of the 200 tested persons were positive for the presence of S. aureus. Of the S. aureus positive persons, 28 (14%) harboured S. aureus produced staphylococcal enterotoxins. The serotypes of these enterotoxins were enterotoxin A (68%), enterotoxin B (36%), enterotoxin C (46%) and enterotoxin D (18%). Some of these isolates produced more than one type of enterotoxins namely AB, AC, BC, BD, ABC and ACD. Analysis of risk factors implicated in skin carriage of S. aureus as age, gender, marital status, education, duration in employment, frequency and method of hand wash and incidence of chronic skin infection revealed insignificant association with staphylococcal skin carriage. The obtained results put forth the risk of food contracting contamination with enterotoxigenic strains of S. aureus owing to skin colonization of S. aureus among food handlers.

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Background:Various sedative and analgesic techniques have been used during shock wave lithotripsy (SWL).Aim:This study aimed at evaluating the efficacy of ultrasound-guided unilateral transversus abdominis plane (TAP) block as an analgesic technique alternative during ureteric SWL.Settings and Design:Prospective randomized comparative study.Materials and Methods:Fifty patients scheduled for ureteric SWL were randomly allocated into two equal groups: Group (F) received 1.5 mcg/kg fentanyl intravenous and group (T) received unilateral TAP block with injection of 25 ml of bupivacaine 0.25% (62.5 mg).Statistical Analysis:Statistical analysis was performed using SPSS program version 19 and EP16 program.Results:The visual analog scale was significantly less in group (T) than in group (F) both intra-operatively (at 10, 20, 30, and 40 min) and postoperatively (at 10 min intervals in the postanesthesia care unit [PACU]) (P < 0.001). Rescue analgesia with pethidine during the procedure and in the PACU was less (P < 0.001) in the group (T) than group (F) with a median of 20 mg versus 55 mg, respectively. The higher sedation scores observed in group (F) at 15, 25, and 35 min during the procedure, and at 20 min during the PACU time were statistically highly significant (P < 0.001), but only significant at 10 min (P = 0.03) and 30 min (P = 0.007) during the PACU time. There was also highly significant decrease (P < 0.001) in the time of PACU stay in group (T) (38.2 ± 6.6 min) compared with group (F) (89.2 ± 13.39 min). We recorded 6 patients in group (F) (24%) who have developed respiratory depression (respiratory rate < 10 breaths/min) compared to 0% in group (T) (P = 0.022). In addition, in group (F) nausea was noted in 8 patients (32%) and vomiting in 6 patients (24%), which was statistically significant when compared to group (T) (0%) (P = 0.01 and 0.022, respectively).Conclusion:Ultrasound-guided unilateral TAP block is an effective alternative analgesic technique during ureteric SWL.

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